13 Weekly medical rounds in psychiatric wards improve identification and treatment of physical illness in a cohort of patients with severe mental illness

Introduction

Excess morbidity and mortality due to poor physical health is well described among people with severe mental illness. Interventions targeting this matter are sparse. We describe an intervention, Liaison somatic, that improves the identification, diagnostics, and treatment of physical illness among patients with severe mental illnesses during admission in psychiatry. The intervention was a liaison service co-designed with patients and consisted of weekly medical ward rounds at adult psychiatric wards. A significant mortality gap persists between people with and without mental illness. Poor physical health contributes significantly to the excess mortality. Different models of shared or integrated care models between mental health services and primary care settings have been tested, however, providing evidence of a feasible and effective method has been difficult. Solid evaluation and evidence of a hospital-based model for integrated care between psychiatric and non-psychiatric services has been called for. The aim of this initiative was to investigate the effect of weekly medical wards rounds in psychiatric wards on the identification and treatment of physical illnesses.

Methods

A cohort study describing the outcomes of weekly medical ward rounds (‘Liaison Somatic’) at Aalborg University Hospital Psychiatry in a subgroup of patients admitted with schizophrenia or bipolar disease from November 2016 - June 2020. The intervention was co-designed with patients and was implemented stepwise in our organisation inspired by the PDSA (Plan-Do-Study-Act)-methodology from August 2017. Outcomes were defined as the utility of selected clinical services and selected clinical interventions. We assessed the effect of the intervention using Statistical Process Control (SPC).

Results

During the study period, 917 unique patients were admitted with a main diagnosis of schizophrenia or bipolar disease. Of these, 193 patients were consulted by the medical team. Each patient received from one to twenty-four consultations within the study period. When considering SPC-charts, the use of chest x-rays, echocardiography’s, urgent cancer referrals, and drug administration for diabetes and hypertension increased. In contrast, immediate transfer to non-psychiatric wards, visits to non-psychiatric out-patient clinics, and drug administration of lung inhalers, cholesterol-lowering medication, and antibiotics did not show the presence of special cause variation Identifying and treating physical co-morbidity during admission to a psychiatric ward using weekly medical ward rounds may be a valuable method to improve physical health in patients with mental illness.

References